Analysis of risk factors affecting prognosis of fulminant myocarditis in children: A ten-year single-center study

Objective : This study aimed to analysis of risk factors affecting prognosis of fulminant myocarditis in children. Methods : We retrospectively reviewed the medical records of all patients (n=40) diagnosed with fulminant myocarditis and admitted to the Cardiac Intensive Care Unit (CICU) and Pediatric Intensive Care Unit (PICU) at the Women and Children's Medical Center of Guangzhou Medical University between January 2014 and December 2023. Patients were divided into two groups based on their in-hospital prognosis: a survival group (n=32) and an non-survival group (n=8). Baseline demographics, laboratory findings, electrocardiograms, echocardiograms, and treatment regimens were compared between the two groups in a multifactorial analysis.using appropriate statistical tests. Results : The median age of patients in the survival group was 7.8 years old (M[5,11.5]), and the median age in the non-survival group was 9.0years old (M[6,11.5]). Compared to the survival group, patients in the non-survival group had significantly higher levels of extracorporeal cardiopulmonary resuscitation(ECPR) use, ventricular tachycardia/ventricular fibrillation (VT/VF), peak creatine kinase isoenzyme (CK-MB), peak N-terminal B-type natriuretic peptide precursor (NT-proBNP), serum creatinine (Scr) on admission and peak, peak aspartate aminotransferase (AST), peak alanine aminotransferase (ALT), peak cardiac troponin I (cTnI), lactate on admission and peak, and extracorporeal membrane oxygenation(ECMO) use (all p <0.05). Binary logistic regression analysis identified peak lactate level as an independent risk factor for mortality in patients with fulminant myocarditis (OR = 0.661, 95% CI 0.488-0.897, p =0.008). Conclusions : This study demonstrates that peak lactate level is an independent risk factor for mortality in patients with fulminant myocarditis.